Although diabetes was almost nonexistent among Native American peoples before 1940, Native Americans now suffer from epidemic rates of diabetes and its complications. Native Americans living in urban areas make up approximately one-half of the U.S. Native American population. Several schools have been established for urban Native American elementary-age school children in the Twin Cities metropolitan area of Minneapolis and St. Paul. These schools provide an exceptionally unique opportunity to design, implement, and evaluate diabetes prevention activities for urban Native American children, during the years that health behavior patterns are generally established. The goal of the proposed five-year study is to demonstrate, among urban Native American school children, the reduction of risk factors associated with diabetes. Risk factors targeted for reduction are physical inactivity, high-fat/low-fiber diets, and obesity. The intent is to develop a comprehensive program to increase physical activity and improve eating habits in Native American children, starting with first and second graders in the first year, and adding two grade levels in each additional year of funding. Classroom curricula, school environmental change, and family involvement programs would be developed, through grade six, for each targeted grade level and behavioral focus. This study will be a quasi-experimental intervention trial with four elementary schools. A fifth school will be used for the development and testing of the intervention. The four schools will be placed into matched pairs and assigned to intervention and control groups. Cohort and cross sectional untreated control group designs with pretest and posttest will be used in the evaluation of the effectiveness of the intervention. The Minnesota Department of Health, the lead agency, has extensive experience in establishing and leading collaborative research and program development. The University of Minnesota, as part of the collaborative team, has extensive experience in research design, especially in community trials of health promotion in school age children. The Indian Health Board of Minneapolis, the first Indian Health Board in the U.S., and also part of the collaborative team, has extensive experience in developing and providing programs and services to urban Indians.